Provider Demographics
NPI:1245590835
Name:ARKANSAS REHABILITATION SERVICES
Entity Type:Organization
Organization Name:ARKANSAS REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SERVICES MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:501-701-6217
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-1358
Mailing Address - Country:US
Mailing Address - Phone:501-701-6217
Mailing Address - Fax:501-624-0019
Practice Address - Street 1:105 RESERVE ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4195
Practice Address - Country:US
Practice Address - Phone:501-701-6217
Practice Address - Fax:501-624-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04D0642139291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57533Medicare UPIN